Lantus Shed/Depot question--confused

Status
Not open for further replies.
C

Christianna

Member Since 2014
I read on one of the threads, but can't locate it right now, that the Lantus shed needs awhile to adjust every time there's a dose adjustment. How long does that take? I also read that the kitty is living off the dose he got 2-3 days ago because that's how long it takes them to settle in. Do I have this right? An explanation or correction would be much appreciated if I have misunderstood. Thanks everyone! :smile:

Christi
 
Re: Lantus Shed/Depot question--confused ???

Pretty close Christi!

We hold each dose for at least 6 cycles (3 days) to see how low it takes them before considering an increase. When they start to get blue nadir's, we hold it for 8-10 cycles

I hope you're able to get another test in though....that drop at +2 is a good early warning system that he MAY be going lower today. I sure hope so. I know how frustrating those pinks and yellows are

Since Noodle is still getting pink and yellow nadirs, I think you could increase tomorrow morning up to 3.25, but let's see what happens for the rest of this cycle and tonight

Here's what you're looking for if I understand your question: (it's in the Sticky at the top of the forum under "LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL")

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
 
Re: Lantus Shed/Depot question--confused ???

Just a quick housekeeping note

We ask that you only post one condo per day. If you think of a question you want to ask after you've posted your original condo, just ask it in that condo as a new comment and then go back to the FIRST post of the day and "Edit" the subject line and add the ? icon

Putting that ? icon on that first post's subject line will let everyone know that your condo contains a question. Once you get your question answered, you can remove the ?....and if you have another question, put it back up there!
 
Re: Lantus Shed/Depot question--confused ???

Someone a while back gave an explanation of how the depot works. Can't remember the full explanation. The used a funnel as the depot, putting water in the funnel was the insulin shot, water running out of the funnel was insulin being used in body.
If someone has the link could you post it. The explanation in those terms really helped me to understand the depot concept.
 
Re: Lantus Shed/Depot question--confused.

Hi Chris and China,
Oh, I'm so sorry--I'm still not entirely up to speed on the etiquette and I apologize for my goof-ups :?
Thanks so much for answering the questions about the settling in of the dose and how long to hold each change. It just seems to me like 3+ units is a lot but apparently that's what Noodle is going to need. The pinks are discouraging, the yellows are a bit better but I won't be happy till we see blues and greens!
Thanks again.

Christi
 
Hi Christi!

Here is a great explanation on the way Lantus works: http://www.diabetesclinic.ca/en/diab/2treat/lantus_vs_levemir.htm

and the yellow-starred sticky, What is the Insulin Depot? is also a great spot to start.

My punkin had acromegaly, which means that the cat needs higher than normal doses. Someone wise told me to keep my eyes on the important numbers - his blood sugar. The dose is not very important. Often we see a new cat in constant higher numbers, but when you hit the "just right" dose, suddenly the whole range of numbers may come down.

Noodle's got a lot of pink and yellow. His nadirs are mostly in the 200's. I wouldn't linger more than 6 cycles on a dose that isn't getting him into normal range (50-120). From the protocol quote that Chris gave you:
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
Click to expand...

You're doing a good job of getting at least 1 mid-cycle test in most cycles. Try to do it every single cycle, then you can be confident you're not missing any low numbers. If he stays yellow and pink til tomorrow morning, I'd increase him by 0.25u for his morning shot to 3.25. The dose you want is the one that gets him into healthy numbers. Some cats just need more, although 3u isn't a high dose at all. Just keep plodding on, following the TR protocol, and you'll get to a better dose for him.
 
There are a number of drugs, not just Lantus and Lev, that are depot medications. The term is from pharmacology and essentially means that a portion of the active drug is stored and gradually absorbed and used. Some depot drugs are very long acting -- they can last for weeks. In the case of insulin, the depot allows for a longer duration.

The way Lantus works, you inject the insulin and because it is slightly acidic and you're injecting into an environment with a different pH, it forms micro crystals. These crystals deposit in the fat tissue under the skin. These crystals dissolve which is why Lantus has a longer duration.

Because you are injecting more insulin every 12 hours and not all of the insulin that has previously been injected is used, there is a "pool" of insulin that your kitty is drawing upon. So, when you increase the dose, it takes a few days for the depot to catch up to the new dose. When you reduce the dose, the depot may be overly full and is likewise can take a few days for the excess insulin to be used up.
 
Thanks so much, Julie. That was some really helpful information. It's hard to just keep plodding along but I know that's what has to be done :? Thanks so much for the links too. Each time I read one, I realize how much I still have to learn. The ol' brain is slow to process some of this information but I'm slowly getting it. I really appreciate your continuing help and advice and Noodle sends sloppy kisses :smile:

Christi
 
Hi Sienne and Gabby,
That was a great and understandable explanation about the depot effect and really helped me visualize it. If I had read about the crystal formation before, unfortunately it didn't stick the first time but I've got it now :smile:
Thanks so much for clarifying that for me. I really appreciate your helping with my continuing education!

Christi
 
Hi Christi - this was a useful thread for me to read too. I'm trying to catch my brain up on all of this after a year's break at the falls. I just got an "aah" moment, after reading about depot for the umteenth time!... :-D

Sienne - the crystals explanation was crystal clear. thanks

Grace
 
Status
Not open for further replies.
Back
Top